Skip to main content Accessibility help

Comparing counseling and dignity therapies in home care patients: A pilot study

  • David Rudilla (a1), Laura Galiana (a2), Amparo Oliver (a2) and Pilar Barreto (a2)



Several studies have successfully tested psychosocial interventions in palliative care patients. Counseling is the technique most often employed. Dignity therapy (DT) has recently emerged as a tool that can be utilized to address patients' needs at the end of life. The aims of our study were to examine the effects of DT and counseling and to offer useful information that could be put into practice to better meet patients' needs.


We developed a pilot randomized controlled trial at the Home Care Unit of the General University Hospital of Valencia (Spain). Some 70 patients were assigned to two therapy groups. The measurement instruments employed included the Patient Dignity Inventory (PDI), the Hospital Anxiety and Depression Scale (HADS), the Brief Resilient Coping Scale (BRCS), the GES Questionnaire, the Duke–UNC-11 Functional Social Support Questionnaire, and two items from the EORTC Quality of Life C30 Questionnaire (EORTC–QLQ–C30).


The results of repeated-measures t tests showed statistically significant differences with respect to the dimensions of dignity, anxiety, spirituality, and quality of life for both groups. However, depression increased in the DT group after the intervention, and there were no differences with respect to resilience. Therapy in the counseling group did not negatively affect depression, and resilience did improve. When post-intervention differences between groups were calculated, statistically significant differences in anxiety were found, with lower scores in the counseling group (t(68) = –2.341, p = 0.022, d = 0.560).

Significance of Results:

Our study provided evidence for the efficacy of dignity therapy and counseling in improving the well-being of palliative home care patients, and it found better results in the counseling therapy group with respect to depression, resilience, and anxiety.


Corresponding author

Address correspondence and reprint requests to David Rudilla, Servicios de Hospitalización Domiciliaria, Consorcio Hospital General Universitario Valencia, Tres Cruces 2, 46014 Valencia, Spain. E-Mail:


Hide All
Arranz, P., Ulla, S.M., Ramos, J.L., et al. (2005). Evaluation of a counseling training program for nursing staff. Patient Education and Counseling, 56(2), 233239.
Barreto, M., Fombuena, M., Diego, R., et al. (2015). Bienestar emocional y espiritualidad al final de la vida [Emotional well-being and spirituality at the end of life]. Medicina Paliativa, 22, 2532.
Bayés, R., Limonero, J.T., Romero, E., et al. (2000). ¿Qué puede ayudarnos a morir en paz? [What can help us to die in peace?]. Medicina Clínica, 115, 579582.
Benito, E., Oliver, A., Galiana, L., et al. (2014). Development and validation of a new tool for the assessment and spiritual care of palliative care patients. Journal of Pain and Symptom Management, 47(6), 10081018.e1.
Bjordal, K., de Graeff, A., Fayers, P.M., et al. (2000). A 12-country field study of the EORTC QLQ–C30 (version 3.0) and the head and neck cancer–specific module (EORTC QLQ–H&N35) in head and neck patients. EORTC Quality of Life Group. European Journal of Cancer, 36(14), 17961807.
Boutron, I., Moher, D., Altman, D.G., et al. (2008). Methods and processes of the CONSORT Group: Example of an extension for trials assessing nonpharmacologic treatments. Annals of Internal Medicine, 148(4), W60W66.
Breitbart, W., Rosenfeld, B., Gibson, C., et al. (2010). Meaning-centered group psychotherapy for patients with advanced cancer: A pilot randomized controlled trial. Psycho-Oncology, 19, 2128.
Breitbart, W., Poppito, S., Rosenfeld, B., et al. (2012). Pilot randomized controlled trial of individual meaning-centered psychotherapy for patients with advanced cancer. Journal of Clinical Oncology, 30, 13041309.
Breitbart, W., Rosenfeld, B., Pessin, H., et al. (2015). Meaning-centered group psychotherapy: An effective intervention for improving psychological well-being in patients with advanced cancer. Journal of Clinical Oncology, 33, 749756.
Broadhead, W.E., Gehlbach, S.H., Degruy, F.V., et al. (1988). The Duke–UNC Functional Social Support Questionnaire: Measurement of social support in family medicine patients. Medical Care, 26(7), 709723.
Callahan, D. (2000). Death and the research imperative. The New England Journal of Medicine, 324, 654656.
Chochinov, H.M. (2002). Dignity-conserving care—a new model for palliative care: Helping the patient feel valued. The Journal of the American Medical Association, 287(17), 22532260.
Chochinov, H.M. (2004). Dignity and the eye of the beholder. Journal of Clinical Oncology, 22(7), 13361340.
Chochinov, H.M. (2012). Dignity therapy: Final words for final days. New York: Oxford University Press.
Chochinov, H.M., Hack, T., Hassard, T., et al. (2002). Dignity in the terminally ill: A cross-sectional, cohort study. Lancet, 360(9350), 20262030.
Chochinov, H.M., Hack, T., Hassard, T., et al. (2005). Dignity therapy: A novel psychotherapeutic intervention for patients near the end of life. Journal of Clinical Oncology, 23, 55205525.
Chochinov, H.M., Hassard, T., McClement, S., et al. (2008). The patient dignity inventory: A novel way of measuring dignity-related distress in palliative care. Journal of Pain and Symptom Management, 36, 559571.
Chochinov, H.M., Kristjanson, L.J., Breitbart, W., et al. (2011). Effect of dignity therapy on distress and end-of-life experience in terminally ill patients: A randomised controlled trial. The Lancet. Oncology, 12(8), 753762.
Cohen, J. (1988). Statistical power analysis for the behavioral sciences. Hillsdale, NJ: Lawrence Erlbaum Associates.
Edmondson, D., Park, C.L., Blank, T.O., et al. (2008). Deconstructing spiritual well-being: Existential well-being and HRQoL in cancer survivors. Psycho-Oncology, 17(2), 161169.
Fegg, M.J. (2006). Strategic therapy in palliative care. European Psychotherapy, 6, 271308.
Fitchett, F., Emanuel, E., Handzo, G., et al. (2015). Care of the human spirit and the role of dignity therapy: A systematic review of dignity therapy research. BMC Palliative Care, 14, 8.
Gysels, M. & Higginson, I. (2004). Improving supportive and palliative care for adults with cancer: Research evidence. London: National Institute for Clinical Excellence.
Hall, S., Edmonds, P., Harding, R., et al. (2009). Assessing the feasibility, acceptability and potential effectiveness of dignity therapy for people with advanced cancer referred to a hospital-based palliative care team: Study protocol. BMC Palliative Care, 8, 5. doi: 10.1186/1472-684X-8-5.
Hall, S., Goddard, C., Opio, D., et al. (2011). A novel approach to enhancing hope in patients with advanced cancer: A randomised phase II trial of dignity therapy. BMJ Supportive & Palliative Care, 1(3), 315321.
Holland, J. (2002). History of psycho-oncology: Overcoming attitudinal and conceptual barriers. Psychosomatic Medicine, 64, 206221.
Houmann, L.J., Chochinov, H.M., Kristjanson, L.J., et al. (2014). A prospective evaluation of dignity therapy in advanced cancer patients admitted to palliative care. Palliative Medicine, 28, 448458.
Julião, M., Oliveira, F., Nunes, B., et al. (2014). Efficacy of dignity therapy on depression and anxiety in Portuguese terminally ill patients: A phase II randomized controlled trial. Journal of Palliative Medicine, 17, 688695.
Kidman, A. & Edelman, S. (1997). Developments in psycho-oncology and cognitive behavior therapy in cancer. Journal of Cognitive Psychotherapy, 11, 4562.
Kissane, D.W., Bloch, S., Smith, G.C., et al. (2003). Cognitive-existential group psychotherapy for women with primary breast cancer: A randomized controlled trial. Psycho-Oncology, 12, 532546.
Kissane, D.W., McKenzie, M., Bloch, S., et al. (2006). Family-focused grief therapy: A randomized, controlled trial in palliative care and bereavement. The American Journal of Psychiatry, 163, 12081218.
Li, M., Fitzgerald, P. & Rodin, G. (2012). Evidence-based treatment of depression in patients with cancer. Journal of Clinical Oncology, 30, 11871196.
Lichtenthal, W.G., Nilsson, M., Zhang., B., et al. (2009). Do rates of mental disorders and existential distress among advanced stage cancer patients increase as death approaches? Psycho-Oncology, 18, 5061.
Lorenz, K.A., Lynn, J., Dy, S.M., et al. (2008). Evidence for improving palliative care at the end of life: A systematic review. Annals of Internal Medicine, 148, 147159.
National Comprehensive Cancer Network. (1999). NCCN practice guidelines for the management of psychosocial distress. Oncology, 13, 113147.
National Consensus Project. (2009). Clinical practice guidelines for quality palliative care, 2nd ed.Pittsburgh: National Consensus Project for Quality Palliative Care.
National Quality Forum. (2006). A national framework and preferred practices for palliative and hospice care: A consensus report. Available from
Newell, S.A., Sanson-Fisher, R.W. & Savolainen, N.J. (2002). Systematic review of psychological therapies for cancer patients: Overview and recommendations for future research. Journal of the National Cancer Institute, 94, 558584.
Peterman, A.H., Fitchett, G., Brady, M.J., et al. (2002). Measuring spiritual well-being in people with cancer: The functional assessment of chronic illness therapy—Spiritual Well-Being Scale (FACIT–Sp). Annals of Behavioral Medicine, 24(1), 4958.
Porche, K., Reymond, L., O'Callaghan, J., et al. (2014). Depression in palliative care patients: A survey of assessment and treatment practices of Australian and New Zealand palliative care specialists. Australian Health Review, 38, 17.
Price, A. & Hotopf, M. (2009). The treatment of depression in patients with advanced cancer undergoing palliative care. Current Opinion in Supportive and Palliative Care, 3, 6166.
Rudilla, D., Barreto, P., Oliver, A. et al. (2015). Estudio comparativo de la eficacia del counselling y de la terapia de la dignidad en pacientes paliativos [Comparative study of the efficacy of counseling and dignity therapy in palliative care patients]. Medicina Paliativa, 22(4). Available from
Sinclair, V.G. & Wallston, K.A. (2004). The development and psychometric evaluation of the Brief Resilient Coping Scale. Assessment, 11(1), 94101.
Spirito, A., Hewett, K. & Stark, L. (1988). The application of behavior therapy in oncology. Advances in Psychosomatic Medicine, 18, 6681.
Tremblay, A. & Breitbart, W. (2001). Psychiatric dimensions of palliative care. Neurologic Clinics, 19(4), 949967.
Uitterhoeve, R., Vernooy, M., Litjens, M., et al. (2004). Psychosocial interventions for patients with advanced cancer: A systematic review of the literature. British Journal of Cancer, 91, 10501062.
Vehling, S. & Mehnert, A. (2014). Symptom burden, loss of dignity, and demoralization in patients with cancer: A mediation model. Psycho-Oncology, 23, 283–90.
World Health Organization (WHO). (2002). National cancer control programmes: Policies and managerial guidelines. Geneva: WHO.
Zigmond, A.S. & Snaith, R.P. (1983). The Hospital Anxiety and Depression Scale. Acta Psychiatrica Scandinavica, 67(6), 361370.


Comparing counseling and dignity therapies in home care patients: A pilot study

  • David Rudilla (a1), Laura Galiana (a2), Amparo Oliver (a2) and Pilar Barreto (a2)


Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed